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�-- ,# FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --- off ------- --- ---- -- ----- ---------------- ------ -- (Comple+e-in Duplicate) --- --------- ---- --------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND WCATION-------3.- ""._-7"( - ------------- Owner's Name--------- --------------- }- Phone Address------------ Contractor's Name -------- ----- tt-+..'tom Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑. Trailer Court Or Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths Lot size Water Supply: Public system,❑ Community system ❑ Private [ K Depth to Water Table%�.p ft i Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,[ " Hardpan ❑ Previous Application Made: {If yes,date----.__.._._..... . } NoX New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest way -.-Distance from foundatioq_fQ___p "._. Material___ --t--C,_/ l i P ` � --- r No. of compartments, Size_ t-_X_J6e_k,_4_Li uid de th__--" - ._- "- . Ca aufi _ Cl17 t I Disposal Field: Distance from nearest well_sr2.---_Distance from foundation___ -- to nearest lot hne____a`j } Number of lines._.." ______ .._ ' Ei ' - -------- -----Length of each line__ ._9C7---.._.fes---.Width of trench_---- -{ -e____"___--_-.- , Type of filter material__._/�t?". "---Depth of filter material----l ""-. Total length _ -Q" - ------- . Seepage Pit: Disfance to nearest wefl---10C./---Distance from foundation-Z' --.'.-_",Distance to nearest lot line__ Number of pits �- --------Lining material.--/rF4& ". Size: Diameter_____ r "� Depth---- Is ------------- Cesspool: Distance from nearest well ________________Distance from foundation._____---- _-"---- -.Lining material------_------------- ----------_"- ' ❑ Size: Diameter_ __ _________ _____ rt _-----,..--'Depth------�_ - ------------- - --------------- ------Liquid Capacity- ------ -----------------gals. Privy:- _ Distance from nearest well------ --------________Distance from nearest building___.__-__..____-..._ El Distance to nearest lot line __________ 1 Remodeling and/or repairing (describe)_........... 4` r_ :-""---- T � I --------- l --------------------------------- ------ -- -------------------------------- L-, .+ -1 - ----•------------------------------------------------- - --------------------- ------------------------------ I hereby certify that 1 have prepared this application and that-the work will be done in accordance with San Joaquin'-County � ordinances, State laws, an rules and regulations of the San Joaquin Local Health District, t - , (Signed) / . C - ... an By ------------- a----• - r Contractor) . wne d o ori ( ) -- ------ ---- 3 (Plot plan, showing size of lot, to ion of syst in relation to well s; buildings, etc., can be pl ed on reverse side). F FOR DEPARTMENT USE ONLY _• APPLICATION ACCEPTED BY_"__ REVIEWED BYO - "' ------------ -------------------------------------------------- ------- -- -------------- DATE_`l-'- j •6.. ------, ---- -----V V . --------- ._--- -- --------- -------- DATE------ ' - ------ BUILDING PERMIT ISSUED-------- -- ----------- ---------------- --------- - - _ DATE------ --------- 'r .`_ ----- aerations and ar recommendations:..______"-__..._ . _ ._ ------•--------- ------ -------------------------- i --------------------------------�- ----------------------------------------------------------- ----------------------------- "------ ------------------ FINAL INSPECTIONo, - -------- Date-- f ." ... SAN-JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy, California E.H.9 2M 1-0 Vanguard Press - - 1